The arguments against DSM-5 are really quite simple and straightforward — and to me seem absolutely compelling. DSM-5 has failed to allow an open, independent and rigorous scientific review of the evidence supporting its suggestions. It is the result of a secretive and closed process that has lost touch with clinical reality. Its suggestions for new diagnoses and for reducing thresholds on old ones will promote a radical explosion in the rates of psychiatric diagnosis that will worsen our country’s already excessive use of medication. Finally, the DSM-5 preoccupation with diagnosing disorders in people who are not really ill will result in a misallocation of resources that disadvantages those most clearly in need them.
I AM MAD, a proud member of the mad community. Of course, madness exists – it’s normal, it’s as old as mankind, and it’s in every family. But if I have a disease in my brain called “mental illness”, I want the doctors to prove it. The brain is the most complicated organ in the body, yet doctors diagnose mental illness just by looking at you, and then you are labelled for life.
I’ve been diagnosed with unipolar depression, bipolar or manic depression, dysphoric elation – whatever that’s supposed to be – and paranoia. I’ve been told that I have a chemical imbalance in my brain that shows I have a mental illness. Yet not one of these fellows even took my pulse. They did it by sitting looking at me and talking to me.
The American Psychiatry Association is now in the middle of a historic and controversial revision of its bible. The fifth and highly anticipated edition, DSM-5, has sparked dissension among psychiatrists and generated more than 8,000 public comments on topics ranging from sexual- and gender-identity issues and anxiety disorders to mind-body problems.
Critics say some of the new entries broadly extend some definitions of mental illness and lower thresholds for some existing disorders, which will result in higher rates of diagnoses. That, they argue, “could result in massive overtreatment with medications that are unnecessary, expensive and often quite harmful,” Dr. Allen Frances, chairman of the DSM,-IV task force, wrote in the Psychiatric Times.
Over the last 40 years the Diagnostic and Statistical Manual of Mental Disorders – the bible of the psychiatric professions – has spawned more and more diagnostic categories, “inventing” disorders along the way and radically reducing the range of what can be construed as normal or sane. Meanwhile Big Pharma, feeding its appetite for profits and ours for drugs, has gained an ever greater hold over our mental and emotional lives, medicalising normality.
Even in these overly medicalised times, where feeling well is increasingly confused with awaiting diagnosis, the idea that well over a third of Europe is suffering from a mental disorder just doesn’t tally with our actual lived experience. After all, does it not seem absurd to think that one in every three Europeans is mentally ill? As many have observed before, absurdity abounds in the psychiatric worldview. The most banal of everyday behaviours, emotional states that I’d wager almost everyone has encountered at some point in their lives, have been given technical, medical-sounding names. So shyness becomes ‘avoidant personality disorder’; anger becomes ‘intermittent explosive disorder’; and if the experts get their way, not throwing stuff away will become ‘hoarding disorder’. In an incredible bit of insightless prose, we are told by DSM’s recent consultation document that, ‘The symptoms [of hoarding disorder] result in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible’.